European Diagnostic Reference Levels for Paediatric Imaging

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An update on the EC tender project PiDRL Despite a large
number of studies available from European countries, the European DRLs for
paediatric patients are only available for some common radiological
examinations. There is a need to consolidate what is available and to provide
guidance on what actions are needed in using DRLs to further enhance radiation
protection of children. The European Commission (EC) recognized this need and
approved a project on the establishment of European DRLs for paediatric
patients in December 2013. The acronym of this project is PiDRL.

The PiDRL
Project

This 27-month tender project was awarded to a consortium, which
is headed by the European Society of Radiology (ESR). Other participating
organisations include the key European stakeholders and professional groups
relating to radiation protection of paediatric patients:

PiDRL is intended to provide European DRLs for the most frequent
paediatric examinations and to promote their use so as to advance the
optimisation of radiation protection of paediatric patients, with a focus on CT
and interventional procedures using fluoroscopy.

The specific objectives of the project are to agree on a
methodology for establishing and using DRLs for paediatric imaging and to
update and extend the European paediatric DRLs.

To fulfill these objectives, this project especially relies
on:

The cooperation of the most relevant European umbrella
organisations and their key experts in this field, supported by a radiation
protection authority with wide experience on setting DRLs and radiation
protection of paediatric patients, further supported by its subcontractors of a
paediatric hospital and an IT expert institute.

A European Workshop to discuss and disseminate the results
of the work packages, in particular the new insights gained, the needs for
further action on DRLs and their use in the optimisation of radiation
protection of paediatric patients.

An Expert Advisory Panel made up by representatives of
national and international organisations.

Interaction with the Working Party on Medical Exposures of
the Article 31 Group of Experts of the EURATOM Treaty during the project
lifetime for feedback on the work performed.

The PiDRL project has very recently drafted European Guidelines
on how to establish and how to use paediatric DRLs.

A comprehensive European and worldwide review of DRLs for paediatric
examinations has indicated that only a few countries have set DRLs for
paediatric examinations and there is a complete lack of national DRLs for many
examinations, in particular for paediatric interventional
fluoroscopically-guided procedures. Furthermore, the existing DRLs are often
adopted from the old EC recommendations or from other countries and only a few
countries have based their DRLs on their own national patient dose surveys. In
many countries, the initial DRLs have never been updated.

Conclusion

There is a need to establish DRLs for radiologic
examinations and procedures where DRLs are not available and provide guidance
on what actions are needed in using DRLs to further enhance radiation
protection of children. PiDRL Guidelines provide an important tool for the
establishment and use of paediatric DRLs for x-ray procedures. These
guidelines cover a wide spectrum of modalities including radiography, computed
tomography and fluoroscopy. Based on the critical review of all paediatric
national DRLs set by authoritative bodies in the European countries, European
DRLs have been suggested for radiography, fluoroscopy and CT. The PiDRL project
has also performed two limited surveys on cardiac fluoroscopically-guided
procedures and non-cardiac fluoroscopically-guided procedures.

Key Points

There is a need to provide guidance on what actions are
needed in using DRLs to further enhance radiation protection of children.

PiDRL aims to promote DRLs to optimise radiation protection
of paediatric patients, with a focus on CT and interventional procedures using
fluoroscopy.

Existing DRLs are often adopted from the old EC
recommendations and very few countries have based their DRLs on their own
national patient dose surveys.